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Medicare's New Claiming System and Related Issues

Medicare's New Claiming System and Related Issues

A Brief Background

Power Diary has had a native integration with Medicare for over 7 years. Millions of Private Patient, Bulk Billed and DVA claims have been processed via our Medicare integration saving practitioners and customers significant amounts of time and money. Until recently Medicare enabled integration with their systems via a technology called Adaptor. 

Over time Medicare formed the view that their adapter-based integration should be retired and that their integration should instead be facilitated via Web Services. This was a significant technological and logistical undertaking by both Medicare and software providers such as Power Diary that integrate with Medicare. Medicare had to develop its new web services-based integration system. Following this, each software provider had to develop a new integration, pass extensive functional testing and security requirements, and then once certified migrate users onto the new integration system. 

Our Journey to Launch of the new Integration

Following notification of Medicare's move to Web Services, we immediately started the preparation and planning stage, with the development of the new system starting well over a year before the formal cutover dates. Once the new integration was built we progressed through and passed Medicare's extensive testing program leading to formal certification. Beta-testing with live claims could then be commenced and following the successful completion of this we began progressively rolling out the new claiming technology. Over the past two months, all Power Diary customers have been migrated and all claims are now being processed exclusively using web services for Medicare Online claiming.

What's different with the new Medicare Claiming System?

Whilst Medicare claims are now being processed by a completely new integration, we have aimed to minimise changes to the workflow and interface as much as possible. Behind the scenes, though Medicare's new integration involves new and increased validations on data elements that didn't exist in the previous integration. To minimise the need for customers to make changes to data entry we made significant efforts to identify and seamlessly handle these requirements when we pass the data to Medicare.  Unfortunately, however, it became evident through the later stages of the rollout that some of the additional restrictions and validations enforced by Medicare's new integration have been challenging for a number of our users, and have led to some noticeable new errors when submitting claims.  We are doing our best to address these issues when they are identified, either via a system update (where possible) or by sharing any advice we receive from Medicare.

Issues Update (18th October 2022)

All Medicare and DVA claim processing issues have now been resolved. If you are experiencing any ongoing issues please contact our Support Team.